Recurrent miscarriage: pathophysiology and outcome
Recurrent miscarriage: pathophysiology and outcome
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DOI：
10.1097/01.gco.0000194112.86051.26
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发表时间：
2005-12-01
影响因子：
2.1
通讯作者：
Regan, L
中科院分区：
文献类型：
--
作者：
Carrington, B;Sacks, G;Regan, L
本文综述了复发性流产病因学的新概念，介绍了新的结局数据，并评价了治疗不明原因复发性流产的新方法。对于有染色体结构异常或不明原因的复发性流产的夫妇，胚胎再植遗传学诊断被认为是一种选择。血栓形成与不良妊娠结局之间的关系被进一步回顾。与此相关，越来越多的人支持使用血栓预防来改善遗传性血栓形成妇女的妊娠结局。非随机研究表明，二甲双胍降低胰岛素抵抗个体的胰岛素水平可能通过恢复正常的止血和改善子宫内膜环境来降低流产风险。关于免疫学概念，现在有证据表明，除了抑制母体细胞介导的免疫外，先天免疫系统的某些成分在成功怀孕中被激活。摘要：除了阿司匹林和肝素预防抗磷脂综合征妇女复发性流产外，在随机对照试验中尚未对这一异质组患者的其他建议治疗进行评估。这些措施包括遗传性血栓病的血栓预防和胰岛素抵抗和/或多囊卵巢综合征妇女使用胰岛素增敏剂。先天免疫系统在妊娠中的作用最近被强调，使用非特异性治疗来抑制母体对妊娠的免疫反应应该被重新评估。
Purpose of reviewThis article reviews new concepts in the aetiology of recurrent miscarriage, presents new outcome data and evaluates new modalities of treatment for unexplained recurrent miscarriage.Recent findingsPreimplantation genetic diagnosis has been considered an option for couples who have structural chromosomal abnormalities or unexplained recurrent miscarriage. The association between thrombophilias and adverse pregnancy outcome is further reviewed, In relation to this, there is increasing support for the use of thromboprophylaxis in improving pregnancy outcome in women with inherited thrombophilias. Nonrandomized studies have shown that the reduction in insulin levels with metformin in insulin-resistant individuals may reduce miscarriage risk by restoring normal haemostasis and improving the endometrial milieu. With respect to immunological concepts there is now evidence to suggest that, in addition to a suppression of maternal cell-mediated immunity, some elements of the innate immune system are activated in successful pregnancies.SummaryWith the exception of aspirin and heparin for the prevention of recurrent miscarriage in women with the antiphospholipid syndrome, no other suggested therapies for this heterogeneous group of patients have been evaluated in randomized controlled trials. These include thromboprophylaxis for inherited thrombophilias and use of insulin sensitizers in women with insulin resistance and/or polycystic ovarian syndrome. The role of the innate immune system in pregnancy was recently highlighted, and use of nonspecific therapies to suppress the maternal immune response to pregnancy should be reassessed.